Critical Matters ECPR
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Aug 14, 2025 Dr. Adam Green, a practicing intensivist and associate professor at Cooper University, joins Dr. Sergio Zanotti to discuss the growing relevance of Extracorporeal Cardiopulmonary Resuscitation (ECPR). They delve into the evolution of ECMO practices, emphasizing patient selection and timing during cardiac arrest. Green highlights the ethical complexities in critical care decisions and the vital role of effective communication with families. The discussion also touches on emerging insights around patient outcomes and the rapid protocols that shape life-saving interventions.
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ECMO Is Rapidly Expanding
- ECMO use has exploded and will likely be far more common in the next decade.
- Intensivists should learn indications and when to transfer patients for ECMO care.
What ECPR Actually Is
- ECPR is cannulating for ECMO during refractory cardiac arrest to restore circulation and oxygenation.
- The goal is to use ECMO to promote ROSC, ideally within 20 minutes of ROSC or during CPR.
Prefer ROSC Before Cannulation
- Prefer ROSC with standard ACLS before using ECPR because ECMO adds complications.
- Start cannulation early when ACLS fails but avoid doing it too early if ROSC may still occur.
